RCAAP Repository

Osteoporosis is a systemic disease characterized by a decrease in bone mass and microarchitecture derangementof bone structure, which enhances the risk of fracture. Although studies focuses in the loss of bone mass in theelderly ages, it is now clear that the bone formed during normal growing period (90% of bone mineralizationoccurs during the first two decades of life) is a determinant factor for the quality of the future mature bone.Appropriate physical activity that implies load, food intake, body mass index and hormonal balance, are allimportant factor in osteoporosis and fracture prevention.In childhood, osteoporosis is secondary to chronic diseases and iatrogenic factors. The most used quantificationand assessment method is the dual energy x-ray absorptiometry (DEXA). Treatment is based in bone remodelinginhibitor drugs associated with load implied physical activities.The aim of early diagnosis and treatment is to prevent disease complications and improve life quality in thisspecific pediatric population.Keywords: Osteoporosis; Child; Densitometry; Applied Kinesiology; Drug Therapy.

Neuropathic pain results from an injury or dysfunction of the somatosensory nervous system. Neuropathic pain exists in children but its incidence is often underestimated. Many of the conditions causing neuropathic pain in adults are rare in children but some forms affect children and adolescents as complex regional pain syndrome or phantom limb pain. The diagnosis of neuropathic pain is clinical and can be difficult, especially in young children or children with developmental disabilities. Treatment strategies that have demonstrated to be efficacious in adults have been extrapolated to be use in pediatric age.

OBJECTIVE: Evaluate the intra- and interrater reliability in the thigh circumference measurement using different anatomical references.MATERIAL AND METHODS: Twenty five volunteers without history of pathology or surgery in the dominant leg entered in the study. The measurements were performed by two independent evaluators, on two occasions with an interval of one week. The  measurements and participants order were randomized. The results of the interim measures were concealed, being analyzed by a third investigator. The assessment protocol was previously defined. The intra- and inter-rater correlation was measured through the intraclass correlation coefficient (ICC). The limits of agreement were established in accordance with the method of Bland and Altman.RESULTS: The intraclass agreement in intrarater reproducibility was high (SPPICC 0,96, KJLICC 0,95, ASISICC 0,96). In the interrater results the limits of agreement were: SPPICC 0,91 (IC 95%: 0,79–0,96), KJLICC 0,94 (IC 95%: 0,86–0,97), ASISICC 0,90  (IC 95%: 0,77–0,95).CONCLUSIONS: All methods presented high intra- and interrater reliability, which by the simplicity of the measurement method may favor the choice for SPP in the absence of pathology in anatomical segment evaluated.  

Spinal cord injury (SCI) is a cause of secondary osteoporosis. The loss of bone mass after a SCI happens throughout the skeleton with greater affection of inferior extremities. This loss of bone is quicker in the first 4 months following a SCI. It continues, however to a lesser degree, over the years. A 56-year-old male patient suffered an automobile accident in 1986 with a concomitant fracture-luxation of C5-C6 vertebrae from which resulted a SCI – classified as a Tetraplegia B in the! American Spinal Cord Injury Association!(ASIA) Scale, with C4 as the neurological level. The patient was admitted to an inpatient Rehabilitation Centre on May 11, 2020, for a comprehensive and multiprofessional rehabilitation. On June 22, 2020, the patient presented with a left thigh crepitation after had been heard a “pop” during passive mobilization of the hip. The Rehabilitation Specialist asked for a radiography. The patient was transferred to an Emergency Department, being diagnosed a spiral diaphyseal fracture of the left femur – a fragility fracture due to sublesional osteoporosis. On June 29, the patient was submitted to an open reduction and internal fixation with an antegrade long nail. The patient returned to the Rehabilitation Centre on July 7 where 70 mg of oral alendronate weekly was introduced. On August 5, control radiographs showed no signs of bone consolidation. Until today, there are no guidelines to treat osteoporosis after a SCI. There are studies in the acute phase of the SCI but there is a lack of evidence when it evolves to chronicity. Bisphosphonates are a class of anti-osteoclast-mediated bone loss osteoporosis who have presented good results!on the BMD, especially oral alendronate, but none demonstrated a diminishing of the fracture risk.

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Lymphedema is the result of lymphatic fluid accumulation in the subcutaneous tissue, usually a chronic and progressive condition associated with a significant morbidity and a decrease on the quality of life of the patients. It can be classified as Primary or Secondary according to the etiopathogeny. Primary lymphedema (PL) results from abnormalities in the lymphatic system development during lymphangiogenesis. Secondary Lymphedema (SL) is the most prevalent and results from an obstruction or dysfunction of the lymphatic system usually as a consequence of infectious disease, neoplastic obstruction or cancer related treatment (lymph node dissection, radiotherapy), surgical interventions, traumatic injuries and some inflammatory diseases. In recent years there has been a increasing scientific interest in this area, especially concerning the physiopathology of the lymphedema, which can give rise to the development of more effective diagnostic and therapeutic approach. The aim of this study is to highlight a clinical case of Primary Lymphedema and to summarize some etiologic, diagnostic and therapeutic findings of Lymphedema. Keywords: Lymphedema Physical Therapy Modalities. 

Introduction: Our objective was to ascertain the incidence of autonomic dysreflexia in spinal cord injury inpatients during the hospitalization; to identify the main triggering factors; to determine which variables influence the incidence of autonomic dysreflexia.Methods: A retrospective review of patients with spinal cord injury was conducted. This study scoped all patients with an injury level above T6 admitted to a physical medicine and rehabilitation department from January 2011 to December 2013. The following data were collected from the medical records: autonomic dysreflexia episodes, demographic information, patient’s characteristics, triggering factors and need of pharmacological treatment. The Statistical Package for the Social Sciences (SPSS) was used to analyze the data.Results: A percentage of 12.7% of the included patients developed autonomic dysreflexia; 71.4% autonomic dysreflexia episodes occurred in patients with complete spinal cord injuries (AIS A). All autonomic dysreflexia episodes occurred in patients with traumatic spinal cord injury and with cervical spinal cord injury levels. The main triggers of autonomic dysreflexia were genitourinary (48%) and gastrointestinal (44.2%). Oral antihypertensive medication was administered in 26.5% of events.Conclusion: Autonomic dysreflexia is an uncommon complication in spinal cord injury patients. It is important to be aware of this condition, since the effective treatment requires early diagnosis, reversal of trigger factors and, if needed, the prompt administration of pharmacological treatment.

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Intensive care unit-acquired weakness (ICU-AW) is recognized as an important and common clinical problem,associated with an increased morbidity in critical ill patients. This muscle weakness has been described in a widerange of clinical settings and therefore, has many different terminologies such as “critical illness myopathy – CIM”,“critical illness polyneuropathy - CIP”, “acute quadriplegic myopathy”, among others. Nowadays, thesedesignations are considered somewhat restrictive, therefore most authors adopt the more wide rangedesignation of “ICU-Acquired Weakness”. Generally, these patients have a flacid tetraparesis without cranial nerve palsy, normal or diminishedosteotendinous reflexes and no sensitive alterations unless on the cases traditionally classified as polyneuropathy.The diagnosis of ICU-AW is often difficult, and should be suspected whenever a critical ill patient has unexplainedweakness. Traditionally, the diagnosis of neuromuscular diseases is based in nerve conduction studies andelectromyography. Muscle biopsy can be used to confirm or exclude myopathy, but is not a routine exam.Since there is a significant percentage of critical patients that develop muscle weakness it is important to screenall patients in the ICU, avoid potential toxic re-exposures on the identified patients and begin early rehabilitation.However, two questions arise from this screening: if the screening is only clinical are we underestimating thesepatients? If electrophysiological are we overestimating ICU-AW?There are no specific therapies for ICU-AW. The criterious use of some drugs is one of the possible measures to betaken. On the other hand, the early inclusion of these patients in a rehabilitation program seems to be helpfulfor a speedy functional recovery.There are few studies regarding ICU-AW, and systematic studies with longer follow-ups and bigger samples arenecessary to determine the most effective rehabilitation approach for these patients.Keywords: Muscle Weakness, Myopathy, Polyneuropathy, Critical illness, Intensive Care Unit.

Introduction: Guillain–Barré syndrome is a frequent acute or subacute polyneuropathy, resulting from an aberrant immune response directed to peripheral nerves, characterized by demyelinating and/or axonal neuropathy. Recurrence is rare and its existence is not consensual.Case presentation: Male, 37 years old, history of severe Guillain–Barré syndrome in 2002, classified as axonal form. In 2012 he presented with acute and progressive motor weakness, involving the cranial nerves and respiratory distress. The electromyography results showed demyelinating motor and sensory polyneuropathy, with axonal component. He started intravenous immunoglobulin treatment with improvement of the neurological disabilities. He was transferred to our Hospital where he completed a broad rehabilitation program. He presented significant functional improvement.Discussion: based on the clinical presentation, electromyography and laboratory results, we considered it a recurrent case of Guillain–Barré syndrome.

Introduction: Neurogenic bladder is commonly found in patients with spina bifida and is associated with an increased risk of nephropathy and renal failure. We evaluated the importance of performing urodynamic studies in the diagnosis and control of vesico-sphincter dysfunction.Material and Methods: Retrospective, descriptive, inferential study of patients followed in a spina bifida consultation between 2011 and 2013. Data was analyzed with Epi Info™ and SPSS®.Results: We studied 96 patients with a mean age of 14 years. Neurogenic bladder was present in 94 patients, a quarter of these had recurrent urinary tract infections. At the time of the first urodynamic studies, 56% were spontaneous emptiers having 50% low age-related bladder capacity and 70% overactive detrusor. It was suggested the introduction of intermittent catheterization in 12%, anticholinergic drug therapy in 44% and both in 39% of the cases. After the first urodynamic study, the anticholinergic drug therapy outcomes were: 27% increased bladder capacity to normal values, 30% gained regular bladder compliance (p=0.031), 60% had no more terminal detrusor hypertonia (p=0.004) and 40% had no more detrusor overactivity (p=0.004). In patients to whom intermittent catheterization were added to anticholinergic drug treatment the outcomes were the following: 57% increased bladder capacity to normal values (p=0.039) , 32% improved bladder compliance, 63% had no more terminal detrusor hypertonia (p=0.039) and 53% had no more detrusor overactivity (p=0.012).Conclusion: Urodynamic studies are crucial in the assessment of bladder behavior, allowing introduction, adjustment, and evaluation of therapeutic measures.

Scoliosis represents a frequent cause for consultation in paediatric patients. Although it can occur secondary to several pathologies, the vast majority of cases are idiopathic. Intramedullary tumors, due to their slow growth and infiltrative behaviour, may present only with scoliosis, without other alterations in the neurological examination. Thus, especially in the early stages, these scoliosis can behave as idiopathic and the distinction between the two entities is difficult. However, a correct identification of the cause of scoliosis is essential in order to guide the treatment of the underlying pathology and stabilize the progression or promote the regression of the scoliosis. In this context, there are several atypical characteristics for scoliosis (red flags) that may alert to the presence of a secondary cause and that should prompt further investigation. This paper presents two clinical cases of adolescents, followed in a specialized PRM consultation (spine static changes), with scoliosis behaving as idiopathic in which, after the onset of neurological symptoms, the presence of an intramedullary neoplasm (pilocytic astrocytoma) was identified. The aim of this paper is to describe this type of lesions, alerting to the main differentiating characteristics of scoliosis secondary to spinal cord tumors in order to allow early identification and treatment.

Pain control in rheumatological disorders is a true clinical challenge because of its multiple presentations. Unsuccessful pain control attempts, add extra difficulty to its management. Osteoarticular chronic symptoms, especially in an advanced phase, are strongly incapacitating but often undervalued despite its functional impact in patient’s life quality. Treatment options are frequently limited by its side effects, being these one of the major problems when handling different pharmacological groups. We report the case of a patient with an enteropathic arthropathy presenting with difficult persisting pain control. It reflects the importance of a correct and rigorous clinical evaluation leading to therapeutic success. Keywords: Analgesics; Arthralgia; Inflammatory Bowel Diseases; Spondylarthropathies.

Background: Spinal cord injury is an important cause of disability, with many physical and psycho-social repercussions. Sexuality in patients with Spinal Cord Injury (SCI) is frequently compromised, determining low levels of satisfaction with it. There are several therapeutic options available nowadays, that can be associated to other interventions, such as psychological and behavioural counseling, pharmacological therapy, penile vibratory stimulation, among others. Despite this fact, it remains as an area least addressed in the long-term SCI patient rehabilitation, with unquestionable repercussions in the individual/couple physical and mental well-being and social and family integration. Objective: Characterize demographic and clinically the population of SCI paraplegic patients followed in a Neurogenic Sexual Dysfunction Consultation, identifying the most common therapeutic interventions done. Methods and Subjects: Retrospective longitudinal study of paraplegic patients followed in a Neurogenic Sexual Dysfunction Consultation, between 2005 and 2008. Socio-demographical, clinical and therapeutic intervention data were collected from clinical files. Results: A total of 178 paraplegic patients were followed in a Neurogenic Sexual Dysfunction Consultation between 2005 April and 2008 December, aged between 18 e 81 years-old and of male gender in the majority. Traumatic etiology was the main cause of SCI, with similar number of complete and incomplete lesions. 48% of patients had neurological levels above D10 and 37% between D10 and L2. 87,7% of the male patients with complete lesions had some type of erection (reflexogenic, psychogenic or both); in incomplete lesions, erection was present in 94,6% . Only 28 % of the males had antegrade ejaculation. Of the non-ejaculating patients, 28 (18%) were submitted to treatment with penile vibratory stimulation, with positive result (antegrade ejaculation) in 43% of those cases. Phosphodiesterase type-5 inhibitors were the commonest therapeutic used in male patients and vaginal lubricant in women. Psychological intervention was provided to 37,6% of patients. Conclusions: SCI impact on sexuality is significant, determining a change on the way the individual and the couple live it. Clinical intervention of Sexual Reeducation allows the patient guidance to a sexuality rediscovery and to make it more satisfying, through the available therapeutic resources, contributing strongly to the psycho-social well-being of the disabled patient. Keywords: Sexual Dysfunction, Physiological; Paraplegia 

Introdução: A osteoartrose do joelho é a patologia articular mais frequente e encontra-se associada a elevada morbilidade. A viscossuplementação intra-articular é uma das terapêuticas mais usadas na osteoartrose refractária à terapêutica convencional, usando o nosso serviço esta técnica desde o ano 2000. Os objectivos deste estudo foram os de avaliar os resultados do tratamento da osteoartrose do joelho com viscossuplementação intraarticular e comparar os resultados entre os três tipos de dispositivos mais frequentemente usados no nosso serviço.Material e Métodos: Os critérios de inclusão foram três administrações sequenciais do mesmo dispositivo de hialuronato, afastados no tempo até 30 dias entre si. Os critérios de exclusão foram a realização de tratamento concomitante para a osteoartrose do joelho. O grupo Hyalartâ (A) teve 176 indivíduos, o grupo Structovialâ (B) foi composto por 117 indivíduos e o grupo Orthoviscâ (C) constituído por 44 indivíduos, totalizando 337 indivíduos. As classificações analisadas basearam-se nos registos padronizados das respostas à mesma questão colocada no início de cada consulta: “Como estão as suas queixas de dor desde a última consulta?”, existindo cinco respostas possíveis dadas pelo doente numa escala tipo Likert: 1- pioria, 2- sem melhoria, 3- melhoria ligeira, 4- melhoria moderada, 5- melhoria acentuada.Resultados: No final dos três tratamentos, existiu uma proporção semelhante de doentes a referir uma “melhoria acentuada”: 19% no Hyalart® (A) e Structovial® (B) e 12% no Orthovisc® (C). O primeiro tratamento não foi eficaz (pioria ou inexistência de melhoria) em 39% dos doentes com “A” (9% pioraram), 17% dos doentes com “B” (7% pioraram) e 75% dos doentes com “C” (28% pioraram).Conclusão: A viscossuplementação intra-articular é um tratamento eficiente das queixas de dor causadas pela gonartrose. O dispositivo derivado de biofermentação teve um resultado mais favorável ao longo dos tratamentos.

Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease with onset in the adulthood. It involves the upper and lower motor neurons with progressive degeneration of the cells and neurons of the anterior horns of the spinal cord. There is no cure, being always fatal, whereby symptomatic and rehabilitative treatment is vitally important. This review aims to group current knowledge about the diagnosis and treatment of ALS in a systematic, comprehensive and easy way to consult, adapted to the Portuguese reality. We made a literature review focused on the treatment and rehabilitation of amyotrophic lateral sclerosis with emphasis in publications of the last 10 years.

Parkinson’s disease is a chronic condition, affecting mainly the motor function. There are several therapeuticoptions. Gait, postural instability and speech are the activities more difficult to improve, and therefore,Rehabilitation assumes in these cases an even more important role. The objective of this paper is to present areview from the literature concerning the rehabilitation of the parkinsonian patient, focusing mainly on themotor function.Keywords: Exercise Therapy, Parkinson Disease, Physical Therapy Modalities.

Objectives: The present study aims to evaluate the effects of adapted sports in psychological well-being of spinal cord injury (SCI) patients.Materials and methods: A qualitative transversal study was developed. The final sample was composed by 28 participants: one of the groups was formed by 11 SCI patients in chronic stage that were at the time performing competition adapted sports; the other group was formed by a similar chronic SCI population that were not doing adapted sports, but with capacity to independently manoeuvre a weal-chair. For the study it was used the Portuguese version of the questionnaire “Échelle de Mesure des Manifestations du Bien-Être Psychologique”. This one is formed by 25 items of self-response, measured in a Likert scale (from 1(never) to 5 (in most cases)), that access the psychological well-being. The result of this measure instrument ranges from 25-125 points and higher individual well-being status are linked to superior scores. Psychometric studies for the Portuguese version demonstrated their reliabilityResults: Using T Student test application for independent samples it was possible to access that comparison groups presented each other statistically significant differences (p < 0,05) in psychological well-being levels. It was found that, both in terms of specific dimensions, and globally, participants that composed the chronic patients group under adapted sports practice exhibit significantly superior mean scores when compared to individuals who were part of the group without adapted sporting activities.Conclusions: The integration in adapted sports teams presents the capacity to produce an increase in psychological well-being in SCIs. In this aspect it is important to alert clinician’s attention to guide such patients to perform sports.

Introdução: As quedas são comuns na doença de Parkinson aumentando a incapacidade e a morbidade. A participação em programas de reabilitação e a modificação de fatores de risco podem melhorar os resultados. Pretendeu-se caraterizar uma população com doença de Parkinson, nomeadamente a autoperceção do equilíbrio e a participação em programas de reabilitação e encontrar possíveis associações com a ocorrência de quedas.Métodos: Estudo retrospetivo e transversal, compreendendo todos os doentes com doença de Parkinson de uma Unidade de Saúde Familiar. Foram definidos dois grupos, os que caíram e os que não caíram anteriormente. Os fatores sociodemográficos, a participação em programas de reabilitação, a pontuação na escala Activities-specific Balance Confidence (ABC-16) e outros fatores de risco foram colhidos através de questionário administrado por telefone e complementado com os registos clínicos. Foi realizada uma análise comparativa entre ambos os grupos, foi calculado o valor de corte para a pontuação da escala ABC-16 e foi realizada uma regressão logística para determinação do efeito das variáveis na probabilidade de ocorrência de quedas.Resultados: Trinta e quatro doentes foram elegíveis após aplicação dos critérios de exclusão, dos quais 29,4% eram fisicamente ativos. No ano precedente, 41,2% realizaram programa de reabilitação e 18 reportaram pelo menos um episódio de queda. O modelo de regressão logística explicou 70% da variância das quedas reportadas (p < 0,005, sensibilidade 87%; especificidade 94%): a pontuação baixa na escala ABC-16 (OR: 0.94), a não participação em programas de reabilitação (OR: 15,3) e o género feminino (OR: 11,4) aumentaram a probabilidade de episódios de queda durante o ano precedente. Foi determinado o valor de corte de 63 para a pontuação da escala ABC-16.Conclusão: A aplicação remota de um questionário incluindo a escala ABC-16 pode representar uma ferramenta de rastreio para avaliar o risco de queda na doença de Parkinson. O género feminino e a não participação em programas de reabilitação esteve associada a história de quedas. Estes achados enfatizam a necessidade de implementação de programas de prevenção de quedas nesses doentes.

Ankle foot orthoses (AFO) are the most frequently prescribed orthoses for the lower limb. Different designs and materials are indicated for specific pathological conditions and their choice must be judicious so that the orthosis fulfills its purpose with minimal impact on the normal range of motion the patient presents. When used for treatment of gait disturbances, accurate diagnosis and recognition of primary and secondary changes is essential. Given the numerous models currently available on the market, knowledge of the basic theoretical notions about the functioning of AFOs is essential to guide the prescription of the most appropriate orthosis.